Iowa Stop Gap, One Step Closer for Individual Healthcare in Iowa

Tuesday, September 19 the Commissioner of the Iowa Insurance Division received notice from CMS (Centers for Medicare and Medicaid Services) that all requirements surrounding the request for the Stop Gap Measure have been met. The last hurdle is a 30 day period for comments.

What is the Iowa Stop Gap Measure?

The State of Iowa sent a request to CMS for an ‘innovative’ plan to replace our dependence on the Federal Marketplace. The ONE plan will be THE option that the carriers (most likely Wellmark and Medica) can offer for all individuals in Iowa losing coverage at the end of 2017. There will still be some premium assistance depending on income, however for those who currently receive Cost Sharing Reduction (CSR) through the Marketplace, will unfortunately will not have these plan reductions available in the Stop Gap Plan.

What is the Plan Design?

The Stop Gap Measure plan is designed as a Silver tier plan. Some of the basic benefits are as follows: $35 Primary Care and $70 Specialist visit copay; $400 copay at the Emergency Room; $300-$400 for higher cost diagnostic radiological scans and $7,350 out of pocket maximum for a single person and $14,300 for a family.

Which Carriers will participate?

We have heard indications that both Medica and Wellmark will participate if the plan is approved. We have NOT heard about network design. This means we do not know if an HMO or PPO or some other type of doctors network will be used.

What next?

There is a 30 day comment period that must be allowed. During this time, what can consumers do? Check out the state’s website and become familiar with the plan, costs and updates. The website can be found at https://stopgap.iowa.gov.

If you are an individual that will be losing coverage, Health Insurance Advisor can assist you with information and enrollment for 2018.

A little more about us:The Business Warrior group has some of the industry’s top experts in all the areas your business needs to be successful. Amongst the contributors is Janis VanAhn, owner of Health Insurance Advisor, LLC. For 19 years Janis has worked in and around the health insurance industry initially providing service to agents and employers related to employee benefits, individual healthcare and Medicare, while more recently becoming appointed as an individual agent with various quality carriers to provide this service to individuals through her own business.

Four years ago Janis was ‘blessed’ with being let go from her job at an insurance ageny. Staying within insurance was her path…but in what capacity. 2010 was the year Janis began her career as an independent insurance agent specializing in health insurance. Finding quality, cost-effective healthcare for individuals and families under age 65 as well as working with those who are Medicare eligible truly was her passion. She has made this a true specialty and positioned herself as someone to work with whether it is a financial professional or property & casualty agent with a client that needs assistance, to a group of seniors turning 65 and they keep receiving Medicare information and are confused about what to do.

Janis enjoys the one on one contact with clients as well as looking forward to speaking to groups about healthcare. Her excitement for this industry is what drives her to stay in tune with Healthcare Reform and what is currently happening and what will happen with coverage from now to past 2014.

‘Educating individual and Medicare consumers to make informed choices’ is her mission because if people are educated and understand, they will make informed choices that they are comfortable with.